Relative efficacy of methylphenidate and behavior modification in hyperkinetic children: An interim report

Abstract

Children reported to be hyperactive in school and with behavior difficulties at home were randomly assigned to methylphenidate, behavior therapy and placebo, or behavior therapy with methylphenidate for an 8-week period. Rating scales were obtained from teachers and parents. Independent blind observers rated childrens' classroom bheavior on a weekly basis. A behavior therapy program was implemented in the home and at school. Methylphenidate dosage was individualized. Ratings of behavior deviance were significantly reduced by all treatments. However, a significant advantage for the groups receiving methylphenidate was found over the group receiving behavior therapy and placebo. No significant differences between methylphenidate alone and methylphenidate combined with behavior therapy were obtained. Global ratings of improvement done by teachers favored the combined treatment of behavior therapy and methylphenidate over behavior therapy and placebo. No differences among treatments were found in the mothers' global ratings of improvement. The results indicate that though all three treatments were effective, methylphenidate was significantly superior to behavior therapy alone.

Decreasing attention deficit hyperactivity disorder symptoms utilizing an automated classroom reinforcement device

“…These findings would also support earlier research (Gittelman-Klein et al, 1976) that suggests that teachers favored combined treatments of behavior therapy and psychostimulant medication over behavior therapy and/or placebo treatment.…”

Behavorial Parent Training and Cognitive-Behavioral Self-Control Therapy With ADD-H Children: Comparative and Combined Effects

“…Rather, the study of the additive effects of different treatment components with hyperactive children has been largely restricted to investigations of the use of behavior therapy with and without psychostimulant medication, the latter also hypothesized to foster external attributions of causality (Whalen & Henker, 1976). Behavioral strategies emphasizing the application of external controls have generally not been found to add significantly to the effects of psychostimulant medication (Gittelman-Klein et al, 1976;Wolraich, Drummond, Salomon, O'Brien, & Sivage, 1978), whereas training in self-control techniques has been found to add to psychostimulant effects (Hinshaw, Henker, & Whalen, 1984;Horn, Chatoor, & Conners, 1983;Pelham, Schnedler, Bologna, & Contreras, 1980;Wells, Conners, Imber, & Delameter, 1981).…”

Ritalin vs. Response Cost in the Control of Hyperactive Children: A Within‐subject Comparison

“…Second, none of the contingency management programs has been compared to titrated dosages of medication. Conversely, titration has been used by Gittelman-Klein, Klein, Abikoff, Gloisten, & Kates (1976), Loney et al (1979), and Gittelman et al (1980), all of whom found greater effects from drugs than behavior therapy. Third, it may be that direct contingency management is a more powerful treatment than traditional behavior therapy, as others have found that reinforcers must provide sufficient cues to direct the child's attention toward specific task demands (Cohen, 1970;Parry, 1973).…”